The Big Interview – Professor Mike Trenell

Professor Mike Trenell is Professor of Metabolism and Lifestyle Medicine at Newcastle University and has a special interest into how lifestyle can impact health. He recently talked at DPC and appeared on a BBC documentary about how adapting the way people live their lives can improve, or even reverse type 2 diabetes.

Aside from your university work, what other organisations are you involved in?

In 2016 I was appointed founding Director of the UK National Institute for Health Research Innovation Observatory where I lead a multidisciplinary team of computer scientists, scientists and evidence synthesis specialists to map, report and shape global healthcare innovation (drugs and non-drugs). I am also co-founder and chief scientific officer of Changing Health.

You have a special interest inhow lifestyle influences lifelong health and wellbeing and chronic disease, particularly diabetes – why?

It’s been a fascinating journey over the last 15 or 20 years. I’ve trained in many places including Leeds, Australia, Newcastle and I’ve also lived in the US and Canada in between. The thing that’s fascinated me all these years is understanding people more and to further understand why some people develop disease and some people don’t. Type 2 diabetes is a great example of why people and behaviour are so important – most people with type 2 diabetes develop it because they eat too much and move too little (on a background of genetic susceptibility).

In a lot of cases type 2 diabetes can be prevented and the advice is quite clear on what we should do, such as controlling weight, exercising more, getting enough sleep. If you manage all those things successfully it is possible to prevent or reverse it, but for some it’s not always that easy. So the challenge, from a behaviour side of things, is to understand how we can make best help people to do the right thing for their health.

What are your main aims and objectives?

Our aim is to help more people with the management of their type 2 diabetes or even reverse it – and that’s really quite a daunting, but motivating, thing to be taking on. The science is clear, but delivering new services involves change. That involves changing how we communicate with patients and how we support patients and how we service our pathways and that’s hugely exciting.

The work you are involved with looks at the effects of exercise and physical activity on certain diseases, what findings have you been surprised at?

One of the powerful things over the last 10 years I think is how diet, physical activity and sleep interact with each other with your health. So if you have poor sleep, you are going to eat poorly and be less active. Alternatively, if you become more active, you get better sleep and diet is most probably going to be better. We need to move away from research silo thinking – and move into exploring what people are doing 24 hours a day. Secondly, we need to put lifestyle behaviours into perspective. While there are clear benefits of physical exercise for people who have type 2 diabetes, if we’re looking for value for money, then we should be putting our efforts into helping people to control their diet and managing their weight. Exercise is part of the second phase of helping people maintain weight loss.

The type 2 diabetes epidemic is fueled by obesity. The human gene hasn’t changed in the last 100 years, so it’s got to be down to our environment. We must look at how we deliver nationwide changes to behaviour. There’s no doubt that our diet and exercise patterns have changed, so it’s not surprise that we’re now having to live with the consequences.

Can you explain some of the large translational programmes you have been involved in which have helped develop novel service pathways for people with chronic disease.

We started our translation programme just over 10 years ago. I was doing a lot of technical stuff, but one patient asked why no one had ever told them that walking was good for diabetes. That was vital to me, because there are very simple messages we could be giving to people. So we started developing the first accredited healthcare programme.

We started doing digital education on DVDs – because you can deliver them at school with good quality control and you can also tailor the information for the individual. So we fast forward to 10 years later and we are in the realms of apps and integrated data. People can instantly get access to structured education and behaviour changing tools.

In the UK we know we know only five per cent of people attend structured education and the most damaging part of that is only 19 per cent of people with type 2 diabetes are offered it. One in 10 people are not offered it at all. It’s not because healthcare professionals don’t believe in it, it’s probably because they don’t have the time. So the really powerful thing for me is technology and giving people access to the right information.

What has been your biggest achievement in diabetes care so far?

The thing I’m very proud of is how we have started to put patients at the core of our programme – essentially they co-design what they need. As a result we now have one of the best structured education progrmmes that can be delivered at scale – Changing Health. A very close second, is having the privilege to work with and support the next generation of diabetes researchers.

What is currently the biggest challenge in diabetes healthcare?

I believe the biggest challenge at the moment is actually delivering what we already know. That is all about looking at how we can transform services at scale and that is not about science – it’s about our behaviour as healthcare professionals and changing what we do. So not doing the same thing every day and going back to basics and delivering the best possible service for people with type 2 diabetes.

How did you become involved in the BBC1’s How to Stay Young?

The BBC approached me to talk about the science of aging. I wrote a study based on what we do to speed up the aging process and one of those elements was type 2 diabetes. It was hugely exciting as we got to talk to people off the street. We had people come into the clinic and you don’t get to see that depth into the emotion and that’s probably what the most important thing is, seeing how people become so emotionally attached to their experiences.